Babies and Reflux

About Dr. Reena Gupta

Dr. Reena Gupta is the Director of the Division of Voice and Laryngology at OHNI. Dr. Gupta has devoted her practice to the care of patients with voice problems. She is board certified in otolaryngology and laryngology and fellowship trained in laryngology, specializing in the care of the professional voice.

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The inevitable follow up to my pregnancy post is this post… about my crying baby. I don’t imagine I’m the first mother to look at her crying infant and pray for some solution. Between old wives’ tales, discussions with parents and grandparents, herbal remedies, and medications, I entertained all options to ease my baby’s tears.

Our visit to our pediatrician resulted in a solution that actually seemed to work: Zantac. This medication, commonly used in babies with acid reflux, definitely made me nervous. It’s the eternal paradox of the physician parent: what’s easy to prescribe for my patients is really hard to give to my baby. I turned off all doctor inclinations, though, and became a good, compliant mother and diligently squirted 1 cc of bitter tasting medication in my tiny baby’s mouth… twice a day! It crushed me to see her wince at the taste. When she learned how to spit it out, it hurt even more to have to hold her little mouth closed until she swallowed. But her crying eased and she seemed so much happier and so I persisted… until the crying resumed two weeks later.

Again, this is a familiar crossroads that parents face: get more aggressive or just stay the course and wait for her to grow out of it. I know enough about babies with reflux to know she would outgrow it; but as a new parent, I didn’t know if I could watch her endure it.

Our pediatrician recommended a stronger type of reflux medication called a proton pump inhibitor (PPI).  I had heard of many babies on Zantac (a histamine blocker) and so it was easier to give it to her.  But this seemed much scarier to me.  I prescribe PPIs to my patients all the time (Prevacid, Nexium, omeprazole, Prilosec, and Protonix are among the many versions of PPIs that patients are familiar with).  Hundreds of studies have proven a benefit in adults but my baby was 8 pounds.

My husband and I thought about it and in the end, the decision actually made itself. She fell asleep early a few nights which meant she missed her evening Zantac. She also slept in a few mornings, so she missed her morning dose. When she didn’t worsen, I deliberately stopped giving her the medication and was amazed to see she was fine. We were lucky; she outgrew her reflux really fast. I am confident she did have it and that Zantac made her better. But nothing made me happier than not having to think about the Prevacid.

Those few days when we were trying to decide, I scoured the literature and baby boards, talked to pediatric gastroenterologists, pediatricians, and pediatric ENTs. The picture that emerged is definitely not black and white. PPIs are only recently being prescribed to infants which means side effects are not yet known. Mothers swear by Prevacid for their babies and are equally adamant that stopping the medication results in a wailing baby. However, a 2011 meta-analysis was published in Pediatrics (the official journal of the American Academy of Pediatrics). A meta-analysis is a type of study that adds up the results of well-designed studies and analyzes their data cumulatively, thereby increasing the power of the study. This study showed that PPIs are “not effective in reducing GERD symptoms in infants.”1 Further “evidence supporting the safety of PPIs is lacking.”

What I’m realizing is that pediatricians are no different than other physicians; we all want to give patients something when they come in with a complaint.  Some patients only feel they are being heard and cared for when they leave with a prescription.  It’s part of the reason antibiotics are so overprescribed (a topic for another blog post). It is hard to tell a patient to just wait. There’s a reason that “Take two of these and call me in the morning” is considered classic doctor-speak, not “Just wait a few days and call me.”

And while I would like to think that as a profession, doctors would be more cautious about the “take two of these” approach in babies, it doesn’t seem to be the case.  I cannot say what I would’ve done if my daughter hadn’t improved so quickly. I honestly would probably have not given her the Preavcid; the lack of data proving a benefit or establishing safety is concerning. I can’t speak to the observation of hundreds of mothers who see a real benefit to these drugs. Like so much in medicine, there are vagaries and gray areas that we can’t explain. All we can do is take the time to listen to our patients, our doctors, our friends and, most importantly, our instincts.

1. van der Pol et al. Efficacy of Proton-Pump Inhibitors in Children with Gastroesophageal Reflux Disease: A Systematic Review. Pediatrics 2011; 127; 925.

 

To learn more about Dr. Reena Gupta or acid reflux, visit: www.voicedoctorla.com

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